Swine flu shots may be at a premium

Massachusetts expects at least 800,000 doses of swine-flu vaccine this fall if the government orders a mass immunization campaign, health officials briefed by the state said.

Massachusetts is planning to get a minimum of 800,000 doses of swine flu vaccine this fall if the government orders a mass immunization campaign, health officials briefed by the state said.

The figure may turn out to be higher, but 800,000 doses would be problematic in a state with 1.3 million students, a population considered a priority for inoculations.

Last year in Massachusetts, 3.5 million doses of flu vaccine were purchased, as elderly residents, people with underlying health issues and others looked to immunize themselves against seasonal influenza.

Whether the H1N1 virus – the scientific name for swine flu – will become a severe public health threat is unknown. But health officials, nervous that H1N1 will grow more potent and arrive in unison with seasonal flu, have stockpiled enough medication to treat 350,000 people for influenza infections if pharmacies and hospitals run out of the anti-viral drugs Tamiflu and Relenza.

State health officials are busily mapping the logistics of a mass swine flu vaccination effort. But key elements remain undecided, such as who will be at the top of the list if a first-run of vaccinations becomes available as early as October, where will vaccines be available and who will administer doses.

Federal health officials on Friday bluntly assessed what is at stake, saying as many as 40 percent of Americans could become infected with H1N1 during the next two years and several hundred thousand could die if a vaccine campaign and other measures fail.

The World Health Organization also made news Friday, estimating that up to 2 billion people – nearly one-third of the world population – could become infected by what it has labeled history’s fastest-spreading pandemic.

“Everyone realizes, if there is a significant outbreak, there probably won’t be the supply to meet the demand,” said Dr. Paul Biddinger, associate director of the Center for Public Health Preparedness at the Harvard School of Public Health.

Mary E. Clark, director of the state’s emergency preparedness bureau, said children may be vaccinated at school, where it would be easier to ensure they receive what may be a necessary second shot administered one month after the first. The second shot could be necessary for everyone.

And Clark said discussions are taking place with hospitals, community health centers, and municipal health departments about ways to make doses available to the public.

Tom Lyons, spokesman for the state Department of Public Health, said the number of doses of vaccine the state gets could far surpass 800,000, a figure he said is being used as a low-end for planning purposes.

According to one health official, the state’s high-end for an initial wave of doses is 1.8 million. Additional doses would follow as pharmaceutical companies produced more. That health officials, and some others interviewed for this story, said they did not want to be identified by name because they were not authorized to speak publicly about the situation.

The state is awaiting direction from the federal Centers for Disease Control and Prevention in several areas, including what circumstances would warrant school closures, and which populations should be vaccinated first.

Medical personnel and first-responders are considered a priority for early vaccination. And the most vulnerable to the virus seem to be children, pregnant women and people with underlying health problems.

More than 1 million Americans are estimated to have been infected with H1N1 since it was detected in Mexico in April, according to the Centers for Disease Control. The virus has not been deemed particularly deadly, although it has killed 800 worldwide, including six in Massachusetts.

President Obama has urged states to plan for what could be the largest immunization campaign since the polio vaccine was distributed in the 1950s.

Such a campaign would be the first real-life test of public health emergency plans developed in response to the 2001 anthrax scares and, later, the avian-flu outbreaks.

A state H1N1 Advisory Committee, convened this week, is exploring so-called social-distancing measures – like canceling sporting events and other large gatherings – that might help control an outbreak if the virus turned more deadly.

Given recent budget cuts and staff reductions, some believe manpower could stymie mass vaccination efforts, especially if local health departments, school nurses and health centers are in the midst of seasonal flu vaccine clinics.

“That, to me, is a severe problem,” said Valerie Bassett, executive director of the Massachusetts Public Health Association.

In Randolph, where there is one town nurse, Public Health Director John P. McVeigh said the town already expects to vaccinate up to 1,200 people against seasonal flu.

“The local boards of health are already understaffed … and we’re the ones the state will turn to,” McVeigh said, referring to a swine flu vaccination.

Massachusetts expects to receive $7.4 million from the federal government, part of a $350 million package to help states prepare for and track swine flu.

Clark said manpower is a concern and money could be used to contract private nurses and extend clinic hours. The state also may turn to volunteer nurses who are part of regional medical reserve corps.

Tests of the new swine-flu vaccine in the United States are to start soon, and federal officials said this week the country may have as many as 160 million doses in October.

What percentage would go to private healthcare providers in the state has not been decided, said Dr. Benjamin Kruskal, director of infection control for Harvard Vanguard Medical Associates.

Kruskal said health officials could face a polar-opposite challenge if H1N1 is mild this fall: convincing people to make time for a vaccination.

“I think we’re all worried about both sides,” Kruskal said. “It will depend a lot on public perception at the time.”

John P. Kelly may be reached at jkelly@ledger.com.

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